Adjournment Matters

Job Losses

Senator David Cullinane

I asked for this debate to focus on the situation in Waterford and the south east. The Minister for Jobs, Enterprise and Innovation was in the House last week to speak on innovation and job creation. During that discussion, Waterford and the south east featured heavily and, in fairness, the Minister gave some commitments that he would work with the enterprise agencies and the Department of Social Protection to ensure the workers who lost their jobs in TalkTalk recently were given the support they need and the broader issue of the lack of job creation in the south east, and the underinvestment in and underperformance of the local and regional economy, and the heavy hits the region has taken in recent years, would be rectified by the enterprise agencies being redirected to deal with the issues and problems facing the region.

I spoke to representatives from all parties and there is a lack of faith in any of the enterprise agencies to deliver for Waterford or for the region. There is a sense that the IDA wants to bring jobs to Ireland and is not bothered about where the jobs go. There is a perception that Waterford and the south east must do things for itself by establishing enterprise fora to examine what we can do in the region. Would the Government support such agencies if they were put in place? The regional assembly in the south east will look at some of these issues.

We cannot allow the situation to disappear from the agenda once the glare of publicity from the job losses is gone. We have seen that happen before when there were major job losses in Waterford Crystal and in GSK in Dungarvan. There was a high media profile and the politicians, Ministers and enterprise agencies had a lot to say. After the focus moves on, however, there is a fear nothing will happen and it is only when more jobs are lost that the focus returns.

Since the Minister for Jobs, Enterprise and Innovation visited Waterford and met public representatives and gave clear commitments, what has been put in place and what action has been taken by Government? Have any specific proposals been put in place? Also, as per the commitment given, has the Department of Social Protection provided support to the workers of Talk Talk? If so, what types of supports have been put in place and is the employee representative forum of Talk Talk satisfied with what has been put in place by the Minister?

It is important that all public representatives from Waterford and the south east continue to raise the issue of the need for a university for the region. I spoke recently with representatives of the friends of the university of the south-east campaign, representatives of which the Leader will recall, protested outside this Parliament two years ago. A clear commitment was given at that time by all political parties, with the exception of the parties in government, that Waterford IT would be designated as a university.

Waterford city is the only gateway city without a university. The south-east region, with a population of 460,000, is the only region without a university. Some €300 million has been invested over the course of the past ten years in Waterford IT. In terms of the application made, many hurdles have been put in place. The Minister of State might recall the process put in place by the previous Government, namely, an expert group was established. The group was overseen by Dr. Port and subsequently published a report. That report stated that in comparison with universities in Ireland and abroad Waterford IT had the academic maturity to be a university and was performing as such in all but name. In my view, that report endorsed the need for a university for the south east.

We then had the Hunt report and clear commitments in that regard from Government. I have no doubt that the public representatives from the Labour Party and Fine Gael who are in government are committed to a university for the south east. Can the Minister of State tell us what the Government has done up to now to help Waterford and the south east and can he provide any further information in regard to Waterford IT's application for university status?

Minister of State at the Department of Jobs, Enterprise and Innovation (Deputy John Perry)

I thank the Senator for raising this matter on the Adjournment.

The Minister, Deputy Bruton, understands the huge blow this is for Waterford, in particular for the workers concerned. The Minister was first informed of this decision on Wednesday, 7 September, the day it was to be announced. He was dismayed, as was the IDA, at the manner in which this was handled. In discussions with the CEO, local management and the representatives of head office in Waterford on Monday, 12 September the Minister continued to press for a longer period of operation to allow workers to adjust and also to give the IDA every chance to market the company effectively as a going concern. A plant with workers and skills is much more saleable while in operation than if closed.

The Minister had a series of meetings with public representatives and business. He met the workers, management and the city manager and business interests in Waterford. The clear message was that Waterford had not benefited from advances in the good times and has been of late badly affected in the more difficult times. On foot of that, the Minister instructed the relevant agencies to put together an action plan for Waterford and the south east region which will intensify how they are being supported and to identify the strengths and weaknesses of the region. This was reflected in the discussions the Minister had with local representatives. There was a sense that there needed to be a hard analysis of the reasons Waterford, given its strengths, has not been more successful. That is the task that the Minister has set the State development agencies to complete within one month.

When that analysis has been completed the Minister will look afresh at what action can be taken and whether there are further, deeper issues that need to be assessed in some other way. The Minister is determined to give Waterford the priority it rightly deserves. It is important to put on the record at this point that the Leader has since the date of the announcement by Talk Talk been raising this issue with the Minister. A casual view of unemployment numbers and the history of industrial performance in recent times indicates there are things that are wrong. The Minister is committed to having an effective action plan to address these. There are issues of a long-term and short-term nature which can be addressed in the near future. We need to take a hard look at how we can better support the enterprise sector in Waterford and to set out the actions we can take in the short and longer term.

The Minister has acknowledged the support of Cabinet colleagues. The Minister for Social Protection responded immediately and staff from her Department have spoken with staff of Talk Talk. The Minister for Education and Skills also responded immediately and the support of FÁS is in place. In addition, the Minister for Education and Skills indicated that work on the proposal for a technological university, which is to be explored as part of the programme for Government, is being accelerated. This issue has also been raised with Government on an ongoing basis by Senator Cummins. Clear criteria will be developed for that opportunity, which arose in discussions.

We need immediate action in the enterprise domain, but the Minister also recognises that this assessment of strengths and weaknesses will throw up issues that are relevant for other Departments. On foot of that, the Minister will bring to the attention of other Departments areas of action in respect of which they have the potential to assist. The Minister accepts that IDA Ireland has been meeting its target for 50% activity outside Dublin. However, for whatever reason, Waterford has not been doing as well as other regions outside the capital. The Minister acknowledges there is an issue as to why Waterford, despite its offerings and significant strengths, is not performing as well. That is why it is important to examine this matter to see what items we can correct in the short term to enhance that performance. It is our ambition to see Waterford doing better from overseas investment arid indigenous companies. We need to create an engine of indigenous growth in this country and it is disappointing to see that the indigenous sector's contribution to our exports has not grown very significantly. We must re-examine weaknesses in that regard.

In this context, the Minister has directed the relevant agencies under his remit to report back to him before the end of this month with an audit of their activity in the region and proposals on what additional efforts can be made to reverse the disproportionately negative trend in employment. This feedback will contribute to and allow the Minister to oversee the preparation and implementation of a south-east employment action plan to investigate the causes of the problems facing Waterford city and its hinterland and will outline a list of actions to be taken by Government over the short, medium and long term to seek to address these.

Senator David Cullinane

I welcome the commitment to develop a south-east employment action plan. It is hoped that plan will be delivered across a number of Departments and will have the support of the Cabinet. While not wishing to be sceptical similar reports and plans put in place have not been followed through. It is hoped that the Minister of State can give a commitment that this plan will be.

On the university issue, the Minister of State referred to clear criteria having to be developed. The point I was making was that this had been a long, almost tortuous process, for Waterford IT. I fail to see what more in terms of criteria needs to be put in place. We have been hearing the word "criteria" for far too long. It is about time the Government published this criteria.

Acting Chairman (Senator Michael Mullins)

I have given the Senator a great deal of latitude and must ask him to conclude now.

Senator David Cullinane

It is an important issue.

Acting Chairman (Senator Michael Mullins)

I know that. The Minister of State has given a commitment on the matter.

Senator David Cullinane

I will continue to raise the matter until the Government delivers on it.

Deputy John Perry

The Government is only in office since March this year. The previous Government may have given a commitment on a proposed action plan but this is this Government's first commitment on an action plan for the south-east region. The Minister has clearly indicated that the relevant Ministers and Departments must devise a plan within a month. I have no doubt that the Minister will meet all public representatives when that timeframe is up. We must await identification of the weaknesses and strengths of the region.

On the university issue, the Minister for Education and Skills is engaged in a review process. Agencies such as Science Foundation Ireland and Enterprise Ireland have continued to provide support to the many excellent research developments taking place in Waterford IT, which have enhanced its reputation. The process has been accelerated. The Government is conscious of the disproportionate lack of investment in Waterford from the State agencies, despite their successes. Indigenous Enterprise Ireland companies have never had higher export levels and the IDA is consistently attracting foreign direct investment. Our job will be to prioritise Waterford in every way we can. The action plan will be formulated in discussion with every parliamentarian in the region and the voluntary and private sector employees and staff. The entitlements of staff will be at the forefront of Government's thinking.

General Medical Services Scheme

Acting Chairman (Senator Michael Mullins)

I welcome the Minister of State, Deputy Shortall, to the House.

Senator Fidelma Healy Eames

I am pleased the Minister of State is present to listen and respond to this Adjournment matter. This is my first time speaking with her in her ministerial capacity. I congratulate and wish her the best of luck.

My request is for the HSE to enable registered nurse prescribers, RNPs, from the private and voluntary nursing home sector to prescribe general medical services, GMS, products for medical cardholders who are nursing home residents. Nurse prescribing was introduced by the then Minister for Health and Children, Ms Mary Harney, and was initially only open to the public sector. The criteria have been changed to allow all nurses to apply, including those from the private and voluntary sectors. Strict criteria, mainly concerning governance and supervision, were put in place.

It has become apparent that there is an issue with RNPs who have completed the course and are registered with An Bord Altranais prescribing for patients with medical cards. This makes no sense, as there is no issue with prescribing to private patients under the same roof. RNPs can prescribe to these patients once they fulfil the terms of an approved collaborative practice agreement but they cannot prescribe using GMS pads in private practice. What is the rationale?

RNPs working in elderly care services in the private sector cannot prescribe for 95% of residents. The number of long-term places for older people in the public sector is limited. Since the introduction of the fair deal, older people can choose where they are placed. Technically, this means that people in private nursing homes are at a disadvantage, as they cannot be treated by RNPs even if their GPs have agreed to that treatment. Circular SO222-NCO-09, of May 2009, alignment of community drug schemes to incorporate nurse and midwife prescriptions, did not reference restrictions to RNPs in the private and voluntary sectors, although it alluded to further circulars to be issued to clarify the policy decision on the GMS scheme. This circular reiterates that the legislation allows registered nurses and midwives who have completed an approved education programme, appropriate clinical experience, registered with An Bord Altranais as RNPs and authority from the health service provider employing them to prescribe a range of medications within their scope of practice. Nowhere within this clarification of the legislation does it refer to restrictions on RNPs in the private or voluntary sector. If so, why can they not prescribe in practice?

In July 2011, Circular 01/311, community registered nurse prescriber primary care prescription pads, outlined specific criteria to apply to community RNPs in the HSE's voluntary and statutory services. RNPs from the private and voluntary nursing home sectors fulfil four of the six, yet the circular states that RNPs in private nursing homes will not be issued with primary care prescription pads. It does not provide a rationale for this decision.

The majority of residents in private and voluntary nursing homes hold medical cards and receive medical services from GPs who are under contract with the HSE. Furthermore, a number of these residents are in beds that have been contracted by the HSE under the contract bed or delayed discharge initiative. When responding to a parliamentary question from Deputy Stanley on 12 April 2011, the Minister for Health, Deputy Reilly, stated:

It is important to note that a person's eligibility for the medical card and drugs payment schemes is unaffected by the nursing homes support scheme. In other words, a person can continue to receive goods and services in accordance with the terms of these other schemes regardless of whether they are in a nursing home or elsewhere.

Given the stress under which the HSE is operating, this issue needs a common sense approach. RNPs offer a vital and cost effective service to older people. Without them, doctors need to be called for emergencies and transfers need to be arranged to accident and emergency departments. The RNP could examine, diagnose and treat people in the interim. The current situation does not make much financial sense.

The HSE should enable RNPs in the private and voluntary nursing home sector to prescribe GMS products for residents who hold medical cards. While the preference would be for RNPs to have primary care prescription pads with their own GMS numbers, it would be acceptable, albeit more difficult in the interim, were the Primary Care Reimbursement Service to issue a circular to GPs concerning GMS prescription pads for RNPs who provide services for the former's patients in private and voluntary nursing homes, as per the practice outlined for practice nurses in the circular to which I referred. I look forward to the Minister of State's reply.

Minister of State at the Department of Health (Deputy Róisín Shortall)

I thank the Senator for raising this issue and for her good wishes.

The introduction of nurse and midwife prescribing is a significant change in nursing and midwifery practice. There is strong international experience that supports such prescribing as being effective and safe and as improving services to patients. Regulations specifying the legislative requirements and conditions for prescribing of medicinal products by nurses and midwives were signed into law in May 2007. The legislation allows registered nurses or midwives to prescribe a range of medications within their scope of practice provided that they have completed an approved education programme, appropriate clinical experience, been registered with An Bord Altranais as a registered nurse prescriber and authority from the health service provider employing them.

I welcome the initiative shown by the nurses and midwives who have undertaken training as part of the nurse prescribing education programmes. Since the legislation came into effect in May 2007, 662 nurses and midwives have been funded by the HSE to undertake these programmes. Some 322 RNPs are in practice and prescribing in 106 health service providers. The remainder are in training or are preparing to register as nurse and midwife prescribers with An Bord Altranais.

The implementation of nurse prescribing in the community is progressing. Of the 322 RNPs, 211 are from acute hospitals, 97 are from primary and continuing care and 14 are from private organisations.

The HSE issued a circular in July 2011 outlining that GMS prescription pads will be made available to nurse prescribers employed by the HSE who are approved at local level and work in collaboration with GPs who are contracted under the GMS. The HSE considers it appropriate to restrict access to GMS prescription pads to this group of nurses at this time. In this regard, it should be noted that there are other restrictions on access to GMS prescription pads. For example, medical practitioners who do not hold GMS contracts with the HSE do not have access to GMS prescription pads, nor do hospital prescribers.

Turning to the position of patients in private nursing homes, general practitioners are contracted by the HSE under the GMS scheme to provide services to medical card and GP-visit cardholders. Such a patient is registered with his or her chosen GP, who acts as a gatekeeper for prescribing choices for his or her panel of patients. Medical cardholders are entitled to retain their medical cards when they move into private nursing homes. They also have the right to retain the GPs of their choice in the same way as if they were living in the community.

GPs receive a significantly enhanced capitation rate for medical card patients in private nursing homes in view of the additional medical care required by such patients. This includes the prescribing of drugs and medicines for such patients. It is clear, therefore, that the restriction on access to GMS pads does not serve to prevent patients in private nursing homes having appropriate access to drugs and medicines.

Any proposal to provide GMS prescription pads to private nursing home employees would require a very significant policy evaluation, involving a full assessment of clinical, patient safety, contractual and financial implications. I regret to inform the Senator there are no plans to make those changes.

Senator Fidelma Healy Eames

Is the reason, therefore, that the GPs are already receiving a significantly enhanced capitation rate, as stated? Is it a matter of cost rather than making best use of the resources? The GP has, apparently, approved the nurse prescriber to do the work. Can it not be arranged between them?

Deputy Róisín Shortall

I envisage a very strong role for nurses in the roll-out of health reforms. They will be critical to the development of primary care. As regards chronic disease management in the community, bearing in mind that we want to see a considerable shift in activity from the hospitals to the community, nurses will be the key professionals involved in delivery. I want far more nurses involved in prescribing. They have a critical role to play in primary care.

With regard to people in nursing homes, there is a real difficulty. As matters stand, the GP is the gatekeeper to the GMS scheme, doctor services, practice nurse services and drugs covered under the GMS. It would be extremely complex to bring about an arrangement whereby a GP responsible for the medical care of a patient in a private nursing home would also have some other professional with prescribing rights working for that patient.

Senator Fidelma Healy Eames

It is a private issue.

Deputy Róisín Shortall

It is. As I stated, GPs are very well recompensed for providing the additional enhanced care for people in nursing homes. When an issue arises and where the patient needs medication, it is the GP who is paid to provide what is required.

Senator Fidelma Healy Eames

I thank the Minister of State for the clarification.

Hospital Services

Senator Brian Ó Domhnaill

I want to raise the provision of X-ray services at two community care hospitals in my constituency, Donegal South-West. I raise this in a week in which there was much controversy surrounding the €6 million in debt being written off by HSE west as a result of not making a claim for insurance money available from private companies. That is a separate issue.

Up to the summer of this year, the community hospital in Killybegs, the country's primary fishing port, and the community hospital in Donegal town provided an X-ray service two days per week to people living in the catchment area in south Donegal, the southern end of my constituency. The service was provided because local community groups in both Donegal town and Killybegs collected almost €300,000 to provide the equipment being used for the X-rays. The HSE made a decision in the early part of the summer to reduce provision in the two locations from two days per week to one day per week, effectively halving the service. Two weeks ago, the HSE made a decision to have the service withdrawn with immediate effect. The service as we know it today is withdrawn. There is no provision of service at Killybegs or Donegal town because the radiographer responsible for providing the service in the two towns was transferred to Letterkenny General Hospital due to staff shortages there. That is what I have been told by the HSE officials.

I understand, on the basis of having liaised with HSE officials, that there is movement. The service must be restored in each of the community hospitals for two days per week. Anything less would be very unfair to both communities which collected the money to provide the equipment.

The only solution to this issue is the full restoration of service for two days per week in both Killybegs and Donegal. If there are staffing issues at Letterkenny General Hospital, they need to be dealt with on their merit and in the context of the moratorium. If there is to be an application made for additional staff at Letterkenny hospital it should be processed, if at all possible, through the Minister of State's Department and then submitted to the Department of Finance. The people in the other part of the county should not have to pay for any staff shortages in another hospital. It is totally unacceptable. I call for the HSE to restore the services not back to one day per week in each community hospital, but to two. I ask that Dungloe Community Hospital, which is in the same constituency, retain its current X-ray service, which is being provided two days per week. I hope the Minister of State can provide some clarification. The issue is pressing and of great concern, particularly to the communities that collected so much money to provide equipment for X-ray services.

Deputy Róisín Shortall

I thank Senator Ó Domhnaill for raising this issue. It provides me with an opportunity to update the House on this matter and to outline the background to the current situation and the action taken by the HSE. As the Senator is aware, the HSE has operational responsibility for the delivery of health and social services, including those at facilities such as community hospitals in Donegal town and Killybegs, County Donegal.

Donegal town community hospital is a HSE residential facility for older people and is located on the outskirts of the town. It is a two-storey building that was established in 1978. The residential unit is located on the ground floor and has a capacity of 29 beds. The unit provides palliative care, respite care, convalescence, rehabilitation, assessment and some continuing care. In addition to residential services, there are also day hospital services, outpatient clinics, child dental services, mental health services and a range of other health services.

Killybegs Community Hospital opened in 2001 and provides a range of services that includes a 41-bed residential centre, a day centre, X-ray facilities, blood testing clinics, physiotherapy and occupational therapy. The residential centre is located on the second floor of the hospital. Accommodation consists of four single rooms, two twin rooms and eight four-bedded rooms. A palliative care suite is also provided allowing family members to stay with their relative at the end of life.

There are 11 public residential care units in Donegal and the HSE has X-ray facilities in a number of these units. Almost 5,900 patients availed of X-ray services in 2010, and between January and May 2011 nearly 2,800 patients used this service. Some curtailment of the X-ray services is necessitated in the community hospitals when the number of radiography staff available to meet the clinical needs of patients attending Letterkenny General Hospital for X-ray services is reduced.

Letterkenny hospital has a complement of 27 radiography staff. Two staff members are on maternity leave, four staff members are on sick leave and two posts are unfilled. The filling of vacant posts has been impacted by the moratorium on recruitment in the HSE. In order to ensure that there is an adequate level of radiographer cover in Letterkenny and to ensure continuity of service in the community, from next Monday, 26 September, the management of the hospital and community services will put in place the following arrangements, based on clinical priority. There will be a radiographer in Killybegs Community Hospital and Donegal Community Hospital one day each per week and there will be a service in Dungloe Community Hospital two days per week. The HSE will keep these arrangements under review depending on the needs of the service.

The Senator will appreciate that all developments have to be addressed in light of the current economic and budgetary pressures and any decisions taken by the executive must have regard to this and the current moratorium on the recruitment of nursing and non-nursing staff. The executive has been asked to make a rigorous examination of how existing funding might be re-allocated to ensure maximum service provision. In particular, we need to ensure the highest standard of care will continue to be provided for all residents in a safe and secure environment. It is a matter for the HSE to deliver services nationally and locally within its budget and overall health policy priorities in line with the overall resources available to it. The executive will continue to work closely with the Department in this context.

Senator Brian Ó Domhnaill

It is a move in the right direction that at least X-ray services will be restored to the level to which they were available during the summer, which is one day per week in each centre.

I ask the Minister of State to ensure the HSE and the Department make every effort to try to fully restore X-ray services to Donegal and Killybegs. I am delighted that Dungloe Community Hospital will have an X-ray service two days per week. I reiterate the importance of returning the other centres to providing a service two days per week, if possible.

The Seanad adjourned at 8 p.m. until 10.30 a.m. on Thursday, 22 September 2011.

Seanad Éireann díospóireacht - Wednesday, 21 Sep 2011